Ambulating post op day zero

[oceangirl1234]

Hi all! Quick question! So, I work on a surgical floor and I am almost at the two year mark. I had an interesting discussion with a colleague the other day about how she never, ever ambulates her patient's post op day zero because of their increased risk for bleeding. She said it does not matter what the procedure was it is a big no-no.

But, I have used my nursing discretion all this time and if the patient is ordered "activity as tolerated", pain is well controlled, and what not then I get them to ambulate. Usually just a few steps or even standing up at the side of the bed. And I take into consideration their procedure, if it was something like a TURP, then yeah get walking. A cystectomy, well no I will probably wait until POD 1 to ambulate.

Any thoughts?

[klone, MSN, RN]

We routinely will see post-cesarean ambulating hours after delivery. Particularly if her infant is in the nursery, it's a big motivator.

"As tolerated" is the key word.

[Rose_Queen, BSN, MSN, RN]

Back in the day, it was thought that all patients needed bedrest after surgery. Is this fellow nurse perhaps from back in those days? They didn't realize how that could contribute to pneumonia and blood clots among other adverse events. Now, we know better. See what your policies and procedures state in addition to provider orders. Heck, my facility has open heart patients out of bed by dinner time.

[MunoRN, RN]

I get my post open-heart patients up within a few hours of coming out of the OR, so I don't think it's a valid blanket rule that patients can't stand or ambulate on the day of surgery. Obviously that depends on the surgery, but generally in the past we were too slow to get patients up, which we thought was good for them for reasons such as bleeding as you mentioned, but as it turns out the sooner most patients get up the better they will do.

[Triddin]

Most ortho we ambulatory pod 1. Large and I surgeries might get a day or two off depending on Dr's orders and pain control. Turns are generally bed rest until pod 1. It's generally better to bullet sooner but I find you need to assess the patient and go from there

[KatieMI, BSN, MSN, RN]

I've once seen a nurse who quietly refused to ambulate patients POD#1 doesn't matter what out of compassion. Her reasoning was that they must be in terrible pain and "all that new stuff they tell you in school about pneumonias and such" was simply excuse for "uncaring" nurses of not doing their job of turning, toileting, fluffing pillows and giving back rubs. She was also very suspicious of heparin shots. It took me a lot of willpower to keep my mouth shut

That nurse was hospital-trained LPN doing bedside longer than I was alive. As far as I know, she is still around there and still precepts students

Re. the question, I really do not think that there must be a hard line. An otherwise healthy 50 years old male and a frail 90 years old female with LVEF 20% and Hb 7.1 preop are too different patients in all possible aspects in order to apply universal "POD#1 OOB as tolerated with PT/OT" order after hip replacement to both of them.

[KelRN215, BSN, RN]

In pediatrics, kids sometimes come out of the PACU jumping out of bed. The only time we didn't get them up immediately when I worked in the hospital (neurology/neurosurgery) was spinal surgery that had to lay flat and prone to prevent a CSF leak for 24 hrs. Depending on the age, those kids could be hard to keep down too.

[RainMom]

We generally ambulate pts within a few hrs after surgery unless extreme pain, nausea/vomiting or hypotension. Our uni knee replacement pts are treated as outpt & get up from the stretcher to walk a few steps upon discharge from PACU. We have also moved towards making TKR outpt procedures if the pt is relatively young & healthy. These pts do get a couple PT sessions before they are discharged home about 5-6 hrs post-op. Typically for inpts, we do have orders to get the pt up in a chair & ambulate by evening if tolerated.

[K+MgSO4, BSN]

Do some research on ERAS. In this they are mobilized in the PACU post bowel surgery to reduce illus risk!

My hips stay in bed until the physio sees them and does the first OOB (hospital policy). Otherwise if an abcess or appendix or even a bowel resection if no restrictions I will take them out.....a first morning case that is back by 10AM on the ward should be sitting up for dinner í ½í¸ after a post op wash.

[Fiona59]

This LPN gets her Gen Surg post ops up and moving unless it clearly says not to.

[mmc51264, BSN, MSN, RN]

We have d/c'd hip replacements POD #0! Not often, but almost everyone gets up POD 0. EOB, stand & pivot but they do something

[Ddestiny, BSN, RN]

When I worked post-surg, I would set up a room where I was expecting a surgery and write on the board the goals for the shift: Void (if no foley -- so many reasons for difficulty urinating post-op), advance diet (where appropriate), pain/nausea management and ambulate with assistance. Unless there was a doctors order for bedrest or there was a very special reason not to (i.e. absolutely uncontrollable N/V, unstable VS, or that one patient that literally vagal'ed everytime her pain spiked....or, in the case of later surgeries, if they were still too lethargic by the end of my shift), then they were up walking POD 0. And when I'd come in on POD 1 I'd update their board to say "Ambulate with assistance x4" and put little hash marks where we could cross off for each walk. I'd titrate the distance with what was appropriate for the patient (some patients are basically running up and down the halls by themselves, while older, frailer folks are having difficulty going farther than the bathroom).

As I left that unit, our surgeons were rolling out the ERAS protocol. I definitely second the person that recommended you look into it -- it's fascinating! Also, as part of it, we'd be getting up people 3 hours after surgery (with the added benefit that they were educated about this ahead of time so they were not shocked about it), and then walking every 3 hours while awake. Read the research and let it guide your practice.